VA Medical Exam

Do You Need a VA Medical Exam for Disability Benefits?

The VA often times makes it difficult to go through the compensation and pension application process. They make you jump through a bunch of hoops and hurdles to qualify for benefits. One of those hoops is the VA medical exam. In this blog we’ll be discussing the VA medical exam process and whether you should be worried if the VA is requesting a reexamination after you’re approved for benefits.

When you’re submitting a claim for VA benefits, you have to submit medical evidence of your disability for compensation purposes. Even if you have a presumptive disability, you still need a medical diagnosis for that condition to be approved for VA benefits. The VA is very clear about that. This is why you should always submit medical records with your claim.

Here we are going to be talking about two different instances in which a VA medical exam may be required. The first would be the VA medical exam that is specific to your disability. This exam establishes the initial diagnosis of your disability for benefits purposes. Secondly, we’ll discuss reexaminations for your particular disability and whether they are necessary or required.

The VA medical exam is commonly called the “C&P” exam, which stands for compensation and pension. The VA has established specific medical protocols or procedures that VA physicians must follow when performing a VA medical exam. They have a book called the VA Clinicians Guide that contains around 57 disability evaluation worksheets pertaining to disabilities for which you could be evaluated. The guide explains that a VA medical exam could vary between doctors, and so they’re basically trying to standardize the process to more easily define your disability and give you a rating for that disability.

You could have a VA medical exam performed by three different doctors and the results might vary depending on the doctor. The VA rating specialist has to reconcile all the reports from different doctors and provide a consistent picture of your present disability. If the diagnosis is not supported by the findings of the VA medical exam, the rating specialist will return the report as inadequate for rating purposes.

Rules for a Valid VA Medical Exam

The VA medical exam must contain a description of the symptoms required to classify your disability, but also a full description of the effects of your disability upon your ordinary life. For example, how does your knee disability impact your life? Are you unemployable as a result of your disability? All these factors are considered in the review. The VA medical exam must be thorough and include all relevant medical history. They look back through your medical records over your lifetime to determine the degree of your disability for benefits purposes.

Let’s say that you have a right knee issue and it’s very painful. As a result, you’re always favoring your right knee. Because your right knee is weak, you’re putting more strain on your left knee. Or maybe you’re putting more strain on your hips because of your painful knee? We have to look at the entire picture here. How does that bad right knee affect your left knee and hips?

The opinion of the examiner has to be based upon the facts in the case. They can’t make any kind of guesses. The VA must pose a hypothetical question to your doctor which fully and accurately reflects your disability picture. The conclusions have to be clear and accompanied by supporting data to allow for an informed decision.

As your advocate, we work with your doctors and help them look through these VA medical exam worksheets. We want to follow the clinician guide so that you can get an accurate description of your disability. We want to provide a clear road map for the VA examiner so that he or she can accurately develop your rating within the rating schedule.

Are VA Reexaminations Necessary?

Now let’s fast forward into the future. You’ve gotten your disability rating and you suddenly get a letter from the VA saying that you need to be reexamined. What do you do? Well first of all, don’t just not show up. You have to respond somehow. The VA rules state that they can require you to be reexamined by a VA physician, even if you’re already receiving compensation. This reexamination may require you to go visit the hospital for observation in order to verify the continued existence or the current severity of your disability.

Generally re-exams are ordered if there is evidence of material change in your disability since the last VA medical exam. This is especially the case if the VA suspects that your disability is likely to have improved. We had a client that had prostate cancer as a result of his exposure to agent orange in Vietnam. His doctor treated him for the cancer and said he was now in remission. The VA interpreted this to mean that he was cured, and they reduced his benefits. We had to fight like crazy to get them back because you’re never truly “cured” from cancer. You’re just in remission.

The VA may also be required to reexamine you to comply with their statutory duty to assist you in the development of your claim. I’ve never actually seen this happen, but that’s one of the reasons they give for administering another VA medical exam.

After VA disability benefits have been granted, the VA will usually schedule a future VA medical exam if your disability is not static. They’ll do this if the VA believes that a future VA medical exam will be needed to justify continued entitlement to disability benefits. After the VA receives the examination reports, your disability rating could be increased, reduced, or continued at the same level.

The VA also may schedule several future exams once it is determined that a reexamination is necessary. These future exams will generally be scheduled two to five years in the future, but that could change depending upon what the VA feels is necessary. The VA doesn’t schedule future examinations for all service connected disabilities or conditions. If your disability is static, a reexamination is usually not required. For example if you have Parkinson’s, it’s either going to get worse or stay the same. That disability is static.

The VA will not reexamine you if your symptoms have persisted without any material improvement for five or more years. They also won’t reexamine you if you’re over the age of 55. And if the minimum disability rating was prescribed after your initial VA medical exam, they won’t order a reexamination.

If the VA schedules you for a VA medical exam and your disability falls into one of those categories that we just discussed, don’t disregard their request. Contact the VA and tell them that you fall into one of those categories and don’t need to be reexamined. Let them make that decision. Don’t make it for them. You need to argue that your reexamination is not necessary under their general guidelines. If the VA refuses to cancel the exam, make sure you go the exam. If you don’t show up, you will be penalized and could possibly lose your VA benefits. As silly as they may seem, don’t ignore their requests.

Contact Us So We Can Help!

If you need assistance with qualifying for VA disability benefits or assistance with the reexamination process, you can complete this form or give us a call at (229) 226-8183. If you’d like to see this blog in video format, you can watch it below. Please be sure to SUBSCRIBE to our YouTube channel and click the bell notification button so that you’re notified each time we publish a new video.